|
HC HTLV I II CONFIRMATION
|
Facility
|
IP
|
$164.38
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
30200276
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$72.33 |
| Max. Negotiated Rate |
$147.94 |
| Rate for Payer: Aetna American Axle |
$106.85
|
| Rate for Payer: Aetna Commercial |
$139.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.85
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cofinity Advantage |
$115.07
|
| Rate for Payer: Cofinity Commercial |
$141.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.50
|
| Rate for Payer: Healthscope Commercial |
$147.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.28
|
| Rate for Payer: PHP Commercial |
$139.72
|
| Rate for Payer: Priority Health SBD |
$103.56
|
| Rate for Payer: UMR Bronson Commercial |
$72.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.28
|
|
|
HC HTLV I II CONFIRMATION
|
Facility
|
OP
|
$164.38
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
30200276
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$147.94 |
| Rate for Payer: Aetna American Axle |
$106.85
|
| Rate for Payer: Aetna Commercial |
$139.72
|
| Rate for Payer: Aetna Medicare |
$20.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.19
|
| Rate for Payer: BCBS Complete |
$10.63
|
| Rate for Payer: BCBS MAPPO |
$19.35
|
| Rate for Payer: BCBS Trust/PPO |
$22.36
|
| Rate for Payer: BCN Commercial |
$22.36
|
| Rate for Payer: BCN Medicare Advantage |
$19.35
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cofinity Advantage |
$115.07
|
| Rate for Payer: Cofinity Commercial |
$141.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$147.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.28
|
| Rate for Payer: Mclaren Medicaid |
$19.35
|
| Rate for Payer: Mclaren Medicare |
$19.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.32
|
| Rate for Payer: Meridian Medicaid |
$20.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.72
|
| Rate for Payer: Nomi Health Commercial |
$29.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.28
|
| Rate for Payer: PACE Medicare |
$18.38
|
| Rate for Payer: PACE SWMI |
$19.35
|
| Rate for Payer: PHP Commercial |
$139.72
|
| Rate for Payer: PHP Medicare Advantage |
$19.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19.35
|
| Rate for Payer: Priority Health Medicare |
$19.35
|
| Rate for Payer: Priority Health SBD |
$103.56
|
| Rate for Payer: Priority Health Tiered Network |
$15.48
|
| Rate for Payer: Railroad Medicare Medicare |
$19.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.03
|
| Rate for Payer: UHC Core |
$29.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19.35
|
| Rate for Payer: UHC Exchange |
$29.03
|
| Rate for Payer: UHC Medicaid |
$10.12
|
| Rate for Payer: UHCCP Medicaid |
$10.12
|
| Rate for Payer: UMR Bronson Commercial |
$60.82
|
| Rate for Payer: VA VA |
$19.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.28
|
|
|
HC HUM/AEROSOL CONTINUOUS
|
Facility
|
OP
|
$386.77
|
|
| Hospital Charge Code |
27000115
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$143.10 |
| Max. Negotiated Rate |
$348.09 |
| Rate for Payer: Aetna American Axle |
$251.40
|
| Rate for Payer: Aetna Commercial |
$328.75
|
| Rate for Payer: Aetna Medicare |
$193.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.40
|
| Rate for Payer: BCBS Complete |
$154.71
|
| Rate for Payer: Cash Price |
$309.42
|
| Rate for Payer: Cofinity Advantage |
$270.74
|
| Rate for Payer: Cofinity Commercial |
$332.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.42
|
| Rate for Payer: Healthscope Commercial |
$348.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$309.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.08
|
| Rate for Payer: PHP Commercial |
$328.75
|
| Rate for Payer: Priority Health SBD |
$243.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.40
|
| Rate for Payer: UHC Core |
$201.51
|
| Rate for Payer: UHC Exchange |
$152.00
|
| Rate for Payer: UMR Bronson Commercial |
$143.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.08
|
|
|
HC HUM/AEROSOL CONTINUOUS
|
Facility
|
IP
|
$386.77
|
|
| Hospital Charge Code |
27000115
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$170.18 |
| Max. Negotiated Rate |
$348.09 |
| Rate for Payer: Aetna American Axle |
$251.40
|
| Rate for Payer: Aetna Commercial |
$328.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.40
|
| Rate for Payer: Cash Price |
$309.42
|
| Rate for Payer: Cofinity Advantage |
$270.74
|
| Rate for Payer: Cofinity Commercial |
$332.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.42
|
| Rate for Payer: Healthscope Commercial |
$348.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.08
|
| Rate for Payer: PHP Commercial |
$328.75
|
| Rate for Payer: Priority Health SBD |
$243.67
|
| Rate for Payer: UMR Bronson Commercial |
$170.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.08
|
|
|
HC HUMAN HERPESVIRUS 6 (HHV-6)
|
Facility
|
IP
|
$53.06
|
|
|
Service Code
|
CPT 87532
|
| Hospital Charge Code |
30600272
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.35 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna American Axle |
$34.49
|
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.49
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Advantage |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: Priority Health SBD |
$33.43
|
| Rate for Payer: UMR Bronson Commercial |
$23.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.80
|
|
|
HC HUMAN HERPESVIRUS 6 (HHV-6)
|
Facility
|
OP
|
$53.06
|
|
|
Service Code
|
CPT 87532
|
| Hospital Charge Code |
30600272
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$52.64 |
| Rate for Payer: Aetna American Axle |
$34.49
|
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$19.27
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$40.57
|
| Rate for Payer: BCN Commercial |
$40.57
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Advantage |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.80
|
| Rate for Payer: Mclaren Medicaid |
$35.09
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$52.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$35.09
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$33.43
|
| Rate for Payer: Priority Health Tiered Network |
$28.07
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.64
|
| Rate for Payer: UHC Core |
$52.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.09
|
| Rate for Payer: UHC Exchange |
$52.64
|
| Rate for Payer: UHC Medicaid |
$18.35
|
| Rate for Payer: UHCCP Medicaid |
$18.35
|
| Rate for Payer: UMR Bronson Commercial |
$19.63
|
| Rate for Payer: VA VA |
$35.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.80
|
|
|
HC HUMAN PAPILLOMAVIRUS HIGH RISK
|
Facility
|
IP
|
$101.05
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
30600221
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$44.46 |
| Max. Negotiated Rate |
$90.94 |
| Rate for Payer: Aetna American Axle |
$65.68
|
| Rate for Payer: Aetna Commercial |
$85.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.68
|
| Rate for Payer: Cash Price |
$80.84
|
| Rate for Payer: Cofinity Advantage |
$70.73
|
| Rate for Payer: Cofinity Commercial |
$86.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.84
|
| Rate for Payer: Healthscope Commercial |
$90.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.79
|
| Rate for Payer: PHP Commercial |
$85.89
|
| Rate for Payer: Priority Health SBD |
$63.66
|
| Rate for Payer: UMR Bronson Commercial |
$44.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.79
|
|
|
HC HUMAN PAPILLOMAVIRUS HIGH RISK
|
Facility
|
OP
|
$101.05
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
30600221
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$90.94 |
| Rate for Payer: Aetna American Axle |
$65.68
|
| Rate for Payer: Aetna Commercial |
$85.89
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$19.27
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$40.57
|
| Rate for Payer: BCCCP Commercial |
$35.09
|
| Rate for Payer: BCN Commercial |
$40.57
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$80.84
|
| Rate for Payer: Cash Price |
$80.84
|
| Rate for Payer: Cofinity Advantage |
$70.73
|
| Rate for Payer: Cofinity Commercial |
$86.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$90.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.79
|
| Rate for Payer: Mclaren Medicaid |
$35.09
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.89
|
| Rate for Payer: Nomi Health Commercial |
$52.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.79
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$85.89
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$35.09
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$63.66
|
| Rate for Payer: Priority Health Tiered Network |
$28.07
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.64
|
| Rate for Payer: UHC Core |
$52.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.09
|
| Rate for Payer: UHC Exchange |
$52.64
|
| Rate for Payer: UHC Medicaid |
$18.35
|
| Rate for Payer: UHCCP Medicaid |
$18.35
|
| Rate for Payer: UMR Bronson Commercial |
$37.39
|
| Rate for Payer: VA VA |
$35.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.79
|
|
|
HC HUMAN PARECHOVIRUS
|
Facility
|
IP
|
$53.06
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600273
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.35 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna American Axle |
$34.49
|
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.49
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Advantage |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: Priority Health SBD |
$33.43
|
| Rate for Payer: UMR Bronson Commercial |
$23.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.80
|
|
|
HC HUMAN PARECHOVIRUS
|
Facility
|
OP
|
$53.06
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600273
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$52.64 |
| Rate for Payer: Aetna American Axle |
$34.49
|
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$19.27
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$40.57
|
| Rate for Payer: BCN Commercial |
$40.57
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Advantage |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.80
|
| Rate for Payer: Mclaren Medicaid |
$35.09
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$52.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.35
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$33.43
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.64
|
| Rate for Payer: UHC Core |
$52.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.09
|
| Rate for Payer: UHC Exchange |
$52.64
|
| Rate for Payer: UHC Medicaid |
$18.35
|
| Rate for Payer: UHCCP Medicaid |
$18.35
|
| Rate for Payer: UMR Bronson Commercial |
$19.63
|
| Rate for Payer: VA VA |
$35.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.80
|
|
|
HC HYALUORAN OR DERIVATIVE, SYN OR SYN1, INTRA-ARTICULAR INJ, 1MG
|
Facility
|
IP
|
$53.06
|
|
|
Service Code
|
CPT J7325
|
| Hospital Charge Code |
63600107
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.35 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna American Axle |
$34.49
|
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.49
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Advantage |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: Priority Health SBD |
$33.43
|
| Rate for Payer: UMR Bronson Commercial |
$23.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.80
|
|
|
HC HYALUORAN OR DERIVATIVE, SYN OR SYN1, INTRA-ARTICULAR INJ, 1MG
|
Facility
|
OP
|
$53.06
|
|
|
Service Code
|
CPT J7325
|
| Hospital Charge Code |
63600107
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna American Axle |
$34.49
|
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna Medicare |
$7.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.70
|
| Rate for Payer: BCBS Complete |
$3.82
|
| Rate for Payer: BCBS MAPPO |
$6.96
|
| Rate for Payer: BCN Medicare Advantage |
$6.96
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Advantage |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.96
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.80
|
| Rate for Payer: Mclaren Medicaid |
$6.96
|
| Rate for Payer: Mclaren Medicare |
$6.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.31
|
| Rate for Payer: Meridian Medicaid |
$7.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$20.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PACE Medicare |
$6.61
|
| Rate for Payer: PACE SWMI |
$6.96
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: PHP Medicare Advantage |
$6.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$25.08
|
| Rate for Payer: Priority Health Medicare |
$6.96
|
| Rate for Payer: Priority Health SBD |
$33.43
|
| Rate for Payer: Priority Health Tiered Network |
$20.06
|
| Rate for Payer: Railroad Medicare Medicare |
$6.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.47
|
| Rate for Payer: UHC Core |
$12.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.96
|
| Rate for Payer: UHC Exchange |
$12.47
|
| Rate for Payer: UHC Medicaid |
$3.64
|
| Rate for Payer: UHCCP Medicaid |
$3.64
|
| Rate for Payer: UMR Bronson Commercial |
$19.63
|
| Rate for Payer: VA VA |
$6.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.80
|
|
|
HC HYALURONAN FOR IA INJ PER DOSE
|
Facility
|
IP
|
$315.18
|
|
|
Service Code
|
HCPCS J7321
|
| Hospital Charge Code |
63600157
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$138.68 |
| Max. Negotiated Rate |
$283.66 |
| Rate for Payer: Aetna American Axle |
$204.87
|
| Rate for Payer: Aetna Commercial |
$267.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.87
|
| Rate for Payer: Cash Price |
$252.14
|
| Rate for Payer: Cofinity Advantage |
$220.63
|
| Rate for Payer: Cofinity Commercial |
$271.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.14
|
| Rate for Payer: Healthscope Commercial |
$283.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.38
|
| Rate for Payer: PHP Commercial |
$267.90
|
| Rate for Payer: Priority Health SBD |
$198.56
|
| Rate for Payer: UMR Bronson Commercial |
$138.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.38
|
|
|
HC HYALURONAN FOR IA INJ PER DOSE
|
Facility
|
OP
|
$315.18
|
|
|
Service Code
|
HCPCS J7321
|
| Hospital Charge Code |
63600157
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$116.62 |
| Max. Negotiated Rate |
$283.66 |
| Rate for Payer: Aetna American Axle |
$204.87
|
| Rate for Payer: Aetna Commercial |
$267.90
|
| Rate for Payer: Aetna Medicare |
$157.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.87
|
| Rate for Payer: BCBS Complete |
$126.07
|
| Rate for Payer: BCBS Trust/PPO |
$236.59
|
| Rate for Payer: BCN Commercial |
$236.59
|
| Rate for Payer: Cash Price |
$252.14
|
| Rate for Payer: Cash Price |
$252.14
|
| Rate for Payer: Cofinity Advantage |
$220.63
|
| Rate for Payer: Cofinity Commercial |
$271.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.14
|
| Rate for Payer: Healthscope Commercial |
$283.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.38
|
| Rate for Payer: PHP Commercial |
$267.90
|
| Rate for Payer: Priority Health SBD |
$198.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.40
|
| Rate for Payer: UHC Core |
$120.40
|
| Rate for Payer: UHC Exchange |
$120.40
|
| Rate for Payer: UMR Bronson Commercial |
$116.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.38
|
|
|
HC HYALURONAN OR DERIVATIVE, DURALONE, INTRAARTICULAR INJ, 1MG
|
Facility
|
OP
|
$21.93
|
|
|
Service Code
|
HCPCS J7318
|
| Hospital Charge Code |
63600163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$21.36 |
| Rate for Payer: Aetna American Axle |
$14.25
|
| Rate for Payer: Aetna Commercial |
$18.64
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.41
|
| Rate for Payer: BCBS Complete |
$3.70
|
| Rate for Payer: BCBS MAPPO |
$6.73
|
| Rate for Payer: BCBS Trust/PPO |
$21.13
|
| Rate for Payer: BCN Commercial |
$21.13
|
| Rate for Payer: BCN Medicare Advantage |
$6.73
|
| Rate for Payer: Cash Price |
$17.54
|
| Rate for Payer: Cash Price |
$17.54
|
| Rate for Payer: Cofinity Advantage |
$15.35
|
| Rate for Payer: Cofinity Commercial |
$18.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.73
|
| Rate for Payer: Healthscope Commercial |
$19.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.45
|
| Rate for Payer: Mclaren Medicaid |
$6.73
|
| Rate for Payer: Mclaren Medicare |
$6.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.07
|
| Rate for Payer: Meridian Medicaid |
$7.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.64
|
| Rate for Payer: Nomi Health Commercial |
$20.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.45
|
| Rate for Payer: PACE Medicare |
$6.39
|
| Rate for Payer: PACE SWMI |
$6.73
|
| Rate for Payer: PHP Commercial |
$18.64
|
| Rate for Payer: PHP Medicare Advantage |
$6.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21.36
|
| Rate for Payer: Priority Health Medicare |
$6.73
|
| Rate for Payer: Priority Health SBD |
$13.82
|
| Rate for Payer: Priority Health Tiered Network |
$17.09
|
| Rate for Payer: Railroad Medicare Medicare |
$6.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.76
|
| Rate for Payer: UHC Core |
$10.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.73
|
| Rate for Payer: UHC Exchange |
$10.76
|
| Rate for Payer: UHC Medicaid |
$3.52
|
| Rate for Payer: UHCCP Medicaid |
$3.52
|
| Rate for Payer: UMR Bronson Commercial |
$8.11
|
| Rate for Payer: VA VA |
$6.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.45
|
|
|
HC HYALURONAN OR DERIVATIVE, DURALONE, INTRAARTICULAR INJ, 1MG
|
Facility
|
IP
|
$21.93
|
|
|
Service Code
|
HCPCS J7318
|
| Hospital Charge Code |
63600163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.65 |
| Max. Negotiated Rate |
$19.74 |
| Rate for Payer: Aetna American Axle |
$14.25
|
| Rate for Payer: Aetna Commercial |
$18.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.25
|
| Rate for Payer: Cash Price |
$17.54
|
| Rate for Payer: Cofinity Advantage |
$15.35
|
| Rate for Payer: Cofinity Commercial |
$18.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.54
|
| Rate for Payer: Healthscope Commercial |
$19.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.45
|
| Rate for Payer: PHP Commercial |
$18.64
|
| Rate for Payer: Priority Health SBD |
$13.82
|
| Rate for Payer: UMR Bronson Commercial |
$9.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.45
|
|
|
HC HYALURONAN OR DERIVATIVE, GEL 1, INTRA-ARTICULAR INJ PER DOSE
|
Facility
|
IP
|
$1,422.02
|
|
|
Service Code
|
CPT J7326
|
| Hospital Charge Code |
63600108
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$625.69 |
| Max. Negotiated Rate |
$1,279.82 |
| Rate for Payer: Aetna American Axle |
$924.31
|
| Rate for Payer: Aetna Commercial |
$1,208.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$924.31
|
| Rate for Payer: Cash Price |
$1,137.62
|
| Rate for Payer: Cofinity Advantage |
$995.41
|
| Rate for Payer: Cofinity Commercial |
$1,222.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,137.62
|
| Rate for Payer: Healthscope Commercial |
$1,279.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$995.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,066.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,208.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,066.52
|
| Rate for Payer: PHP Commercial |
$1,208.72
|
| Rate for Payer: Priority Health SBD |
$895.87
|
| Rate for Payer: UMR Bronson Commercial |
$625.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,066.52
|
|
|
HC HYALURONAN OR DERIVATIVE, GEL 1, INTRA-ARTICULAR INJ PER DOSE
|
Facility
|
OP
|
$1,422.02
|
|
|
Service Code
|
CPT J7326
|
| Hospital Charge Code |
63600108
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$275.51 |
| Max. Negotiated Rate |
$1,669.26 |
| Rate for Payer: Aetna American Axle |
$924.31
|
| Rate for Payer: Aetna Commercial |
$1,208.72
|
| Rate for Payer: Aetna Medicare |
$547.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$924.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$658.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$658.49
|
| Rate for Payer: BCBS Complete |
$289.31
|
| Rate for Payer: BCBS MAPPO |
$526.79
|
| Rate for Payer: BCN Medicare Advantage |
$526.79
|
| Rate for Payer: Cash Price |
$1,137.62
|
| Rate for Payer: Cash Price |
$1,137.62
|
| Rate for Payer: Cofinity Advantage |
$995.41
|
| Rate for Payer: Cofinity Commercial |
$1,222.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,137.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$526.79
|
| Rate for Payer: Healthscope Commercial |
$1,279.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$995.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,066.52
|
| Rate for Payer: Mclaren Medicaid |
$526.79
|
| Rate for Payer: Mclaren Medicare |
$526.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$553.13
|
| Rate for Payer: Meridian Medicaid |
$553.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$605.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$579.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,208.72
|
| Rate for Payer: Nomi Health Commercial |
$1,580.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,066.52
|
| Rate for Payer: PACE Medicare |
$500.45
|
| Rate for Payer: PACE SWMI |
$526.79
|
| Rate for Payer: PHP Commercial |
$1,208.72
|
| Rate for Payer: PHP Medicare Advantage |
$526.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$275.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,669.26
|
| Rate for Payer: Priority Health Medicare |
$526.79
|
| Rate for Payer: Priority Health SBD |
$895.87
|
| Rate for Payer: Priority Health Tiered Network |
$1,335.41
|
| Rate for Payer: Railroad Medicare Medicare |
$526.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$871.28
|
| Rate for Payer: UHC Core |
$871.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$526.79
|
| Rate for Payer: UHC Exchange |
$871.28
|
| Rate for Payer: UHC Medicaid |
$275.51
|
| Rate for Payer: UHCCP Medicaid |
$275.51
|
| Rate for Payer: UMR Bronson Commercial |
$526.15
|
| Rate for Payer: VA VA |
$526.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,066.52
|
|
|
HC HYDROCODONE AND MTB, FREE
|
Facility
|
IP
|
$101.96
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100685
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.86 |
| Max. Negotiated Rate |
$91.76 |
| Rate for Payer: Aetna American Axle |
$66.27
|
| Rate for Payer: Aetna Commercial |
$86.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.27
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cofinity Advantage |
$71.37
|
| Rate for Payer: Cofinity Commercial |
$87.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.57
|
| Rate for Payer: Healthscope Commercial |
$91.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.47
|
| Rate for Payer: PHP Commercial |
$86.67
|
| Rate for Payer: Priority Health SBD |
$64.23
|
| Rate for Payer: UMR Bronson Commercial |
$44.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.47
|
|
|
HC HYDROCODONE AND MTB, FREE
|
Facility
|
OP
|
$101.96
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100685
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$91.76 |
| Rate for Payer: Aetna American Axle |
$66.27
|
| Rate for Payer: Aetna Commercial |
$86.67
|
| Rate for Payer: Aetna Medicare |
$50.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.27
|
| Rate for Payer: BCBS Complete |
$40.78
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cofinity Advantage |
$71.37
|
| Rate for Payer: Cofinity Commercial |
$87.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.57
|
| Rate for Payer: Healthscope Commercial |
$91.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.47
|
| Rate for Payer: PHP Commercial |
$86.67
|
| Rate for Payer: Priority Health SBD |
$64.23
|
| Rate for Payer: UMR Bronson Commercial |
$37.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.47
|
|
|
HC HYDROCORTIZONE CREAM
|
Facility
|
OP
|
$10.12
|
|
| Hospital Charge Code |
27000116
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$9.11 |
| Rate for Payer: Aetna American Axle |
$6.58
|
| Rate for Payer: Aetna Commercial |
$8.60
|
| Rate for Payer: Aetna Medicare |
$5.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.58
|
| Rate for Payer: BCBS Complete |
$4.05
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cofinity Advantage |
$7.08
|
| Rate for Payer: Cofinity Commercial |
$8.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.10
|
| Rate for Payer: Healthscope Commercial |
$9.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.59
|
| Rate for Payer: PHP Commercial |
$8.60
|
| Rate for Payer: Priority Health SBD |
$6.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.58
|
| Rate for Payer: UHC Core |
$5.27
|
| Rate for Payer: UHC Exchange |
$3.98
|
| Rate for Payer: UMR Bronson Commercial |
$3.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.59
|
|
|
HC HYDROCORTIZONE CREAM
|
Facility
|
IP
|
$10.12
|
|
| Hospital Charge Code |
27000116
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$9.11 |
| Rate for Payer: Aetna American Axle |
$6.58
|
| Rate for Payer: Aetna Commercial |
$8.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.58
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cofinity Advantage |
$7.08
|
| Rate for Payer: Cofinity Commercial |
$8.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.10
|
| Rate for Payer: Healthscope Commercial |
$9.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.59
|
| Rate for Payer: PHP Commercial |
$8.60
|
| Rate for Payer: Priority Health SBD |
$6.38
|
| Rate for Payer: UMR Bronson Commercial |
$4.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.59
|
|
|
HC HYDRODISSECTION TENDON LEG/ANKLE
|
Facility
|
OP
|
$686.66
|
|
|
Service Code
|
CPT 27899
|
| Hospital Charge Code |
76100417
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna American Axle |
$446.33
|
| Rate for Payer: Aetna Commercial |
$583.66
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$446.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$225.47
|
| Rate for Payer: BCN Commercial |
$225.47
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cofinity Advantage |
$480.66
|
| Rate for Payer: Cofinity Commercial |
$590.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$617.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$480.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$515.00
|
| Rate for Payer: Mclaren Medicaid |
$245.78
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$258.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.66
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$515.00
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$583.66
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$794.84
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health SBD |
$432.60
|
| Rate for Payer: Priority Health Tiered Network |
$635.87
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$446.33
|
| Rate for Payer: UHC Core |
$357.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$269.86
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: UMR Bronson Commercial |
$254.06
|
| Rate for Payer: VA VA |
$245.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$515.00
|
|
|
HC HYDRODISSECTION TENDON LEG/ANKLE
|
Facility
|
IP
|
$686.66
|
|
|
Service Code
|
CPT 27899
|
| Hospital Charge Code |
76100417
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.13 |
| Max. Negotiated Rate |
$617.99 |
| Rate for Payer: Aetna American Axle |
$446.33
|
| Rate for Payer: Aetna Commercial |
$583.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$446.33
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cofinity Advantage |
$480.66
|
| Rate for Payer: Cofinity Commercial |
$590.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.33
|
| Rate for Payer: Healthscope Commercial |
$617.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$480.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$515.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$515.00
|
| Rate for Payer: PHP Commercial |
$583.66
|
| Rate for Payer: Priority Health SBD |
$432.60
|
| Rate for Payer: UMR Bronson Commercial |
$302.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$515.00
|
|
|
HC HYDROXYPREGNENOLONE 17
|
Facility
|
OP
|
$90.51
|
|
|
Service Code
|
CPT 84143
|
| Hospital Charge Code |
30100399
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$81.46 |
| Rate for Payer: Aetna American Axle |
$58.83
|
| Rate for Payer: Aetna Commercial |
$76.93
|
| Rate for Payer: Aetna Medicare |
$23.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.51
|
| Rate for Payer: BCBS Complete |
$12.53
|
| Rate for Payer: BCBS MAPPO |
$22.81
|
| Rate for Payer: BCBS Trust/PPO |
$26.37
|
| Rate for Payer: BCN Commercial |
$26.37
|
| Rate for Payer: BCN Medicare Advantage |
$22.81
|
| Rate for Payer: Cash Price |
$72.41
|
| Rate for Payer: Cash Price |
$72.41
|
| Rate for Payer: Cofinity Advantage |
$63.36
|
| Rate for Payer: Cofinity Commercial |
$77.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.81
|
| Rate for Payer: Healthscope Commercial |
$81.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.88
|
| Rate for Payer: Mclaren Medicaid |
$22.81
|
| Rate for Payer: Mclaren Medicare |
$22.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.95
|
| Rate for Payer: Meridian Medicaid |
$23.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.93
|
| Rate for Payer: Nomi Health Commercial |
$34.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.88
|
| Rate for Payer: PACE Medicare |
$21.67
|
| Rate for Payer: PACE SWMI |
$22.81
|
| Rate for Payer: PHP Commercial |
$76.93
|
| Rate for Payer: PHP Medicare Advantage |
$22.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22.81
|
| Rate for Payer: Priority Health Medicare |
$22.81
|
| Rate for Payer: Priority Health SBD |
$57.02
|
| Rate for Payer: Priority Health Tiered Network |
$18.25
|
| Rate for Payer: Railroad Medicare Medicare |
$22.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.22
|
| Rate for Payer: UHC Core |
$34.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22.81
|
| Rate for Payer: UHC Exchange |
$34.22
|
| Rate for Payer: UHC Medicaid |
$11.93
|
| Rate for Payer: UHCCP Medicaid |
$11.93
|
| Rate for Payer: UMR Bronson Commercial |
$33.49
|
| Rate for Payer: VA VA |
$22.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.88
|
|
